Chronic Non-cancer Pain Management and Addiction: A Review

Abstract

The use of opioids in chronic non-cancer pain (CNCP) has been a fast-rising treatment phenomenon in the last two decades. Though opioids are advocated in various chronic pain management guidelines, their use in chronic non-cancer pain still remains controversial as evidence of this approach is still weak. This paper highlights potential adverse effects associated with opioid use in pain management, including an increase in tolerance, dependence, and addiction outcomes. Nonetheless, opioids have an important place in contemporary CNCP management for selected patients. However, pain management must involve regular monitoring and the use of a multimodal pain management strategy. It is essential that the treating physician must be up-to-date with the form of therapy so that they have the requisite confidence to prescribe opioids and effectively manage adverse effects. Moreover, the adverse effects should be treated promptly to enhance patient compliance. Since this approach is beneficial for some patients, opioid treatment should only be applied on a case by case basis.

Cues conditioned to withdrawal and negative reinforcement: Neglected but key motivational elements driving opioid addiction

“…Among them, 11.5 million had engaged in opioid misuse. The primary reason respondents gave for opioid misuse was physical pain relief ( 43 ). Aversive affective states, including depression and anhedonia, often accompany chronic pain, and a high degree of aversive affect increases the risk for misuse of prescription opioids ( 44 ).…”

The Association between Dysbiosis and Neurological Conditions Often Manifesting with Chronic Pain

“…Opioid analgesics are the mainstay for cancer pain patients but their use in chronic non-cancer pain (CNCP) has limited success [ 8 ]. CNCP is moderate or severe pain with long-term duration often associated with osteoarthritis, neuropathic pain, FSSs, e.g., fibromyalgia and autoimmune conditions, e.g., rheumatoid arthritis, amongst other conditions ( Table 1 ) [ 9 ]. While the use of opioids for long-term treatment of pain does not appear effective in reducing pain levels [ 7 ], the risks associated with opioid use include opioid tolerance, diversion, addiction, overdose and death [ 10 ].…”

A mobile health + health coaching application for the management of chronic non-cancer pain in older adults: Results from a pilot randomized controlled study

“…Older adults are disproportionately affected by chronic diseases, many of which have pain as a primary symptom ( 2 ). Chronic non-cancer pain (CNCP) is a common, morbid, and costly condition among older adults ( 3 ). As the number of older adults with CNCP continues to rise and the need for virtual methods of healthcare delivery increases given the ongoing COVID-19 pandemic, researchers have begun to examine whether mobile health devices (hereafter referred to as mHealth) can enhance the management of pain in patients in this age group ( 4 ).…”